Alcohol Consumption, Life Course Transitions and Health in Later Life Research Team: Keele University University College of London Clare Holdsworth, PI Nicola Shelton Marina Mendonça Hynek Pikhart Martin Frisher Cesar de Oliveira Presentation • Introduction to the project • Data and methodology • Findings: – Cross-sectional analysis of drinking profiles and health – Longitudinal analysis of drinking quantity and frequency over time • Policy implications Research Objectives • To extend understanding of the diversity of patterns of alcohol consumption at older ages; • To identify the socio-demographic dynamics of drinking during later life and the life events that are associated with changes in drinking behaviours; • To explore the relationship between drinking and health conditions in later life; • To establish the importance of secondary survey data in supporting policy initiatives directed towards individual health behaviours; • To inform health policy initiatives on drinking in later life through identifying the risks associated with excessive drinking (binge drinking or drinking more than recommended weekly amounts) and the relationship between alcohol consumption, health and well-being in later life. Data & Methodology • English Longitudinal Study of Ageing (ELSA): ELSA W0 (HSE): Baseline for alcohol variables 1998 1999 2001 W1 2002/3 W2 W3 W4 2004/5 2006/7 2008/9 W5 W6 2010/11 2012/13 • Practice-informed modeling approach in collaboration with Beth Johnson Foundation • Cross-sectional analysis: Association between alcohol consumption and socio-demographic and health variables • Longitudinal analysis: Sequencing drinking behaviours over life course; link between drinking behaviours and health; identifying whether changes in drinking behaviours are associated with individual characteristics Table 1: Percentage distribution of drinking profiles by gender, wave 0 . Drinking Variables Drinking Status Quantity of Alcohol % Respondents wave 0 Frequency of drinking Non-drinker Drinker Drinking Profiles Men Women Non-Drinker 7 14 Below Recommended Limits (Men ≤21 units; Women≤ 14 units) Occasional (≤ 4 days) Low Risk: Occasional Drinker 54 64 Daily (≥ 5days) Low Risk: Daily Drinker 12 8 Above Recommended Limits (Men > 21 units Women > 14 unit) Occasional (≤ 4 days) Focal Drinker 7 3 Daily (≥ 5days) Heavy Drinker 20 11 Number of cases = 11205 Figure 1: Percentage Distribution of Drinking profiles by age and gender: wave 0 Non-drinker Low Risk:Occas. Low risk: Daily Focal Heavy 80 70 60 50 40 30 20 10 0 Men 45-64 Women 4564 Number of cases = 11205 Men 65-74 Women 6574 Men 75+ Women 75 + Figure 2: Percentage of drinking profiles with poor self-rated: wave 0 and wave 5 Wave 0 20 18 16 14 12 10 8 6 4 2 0 Wave 5 Non-drinker: Non-drinker: Always Stopped drinking Number of cases = 5868 Low Risk Steady Focal Heavy Figure 3a and b: Unadjusted and adjusted odds ratios predicting poor self rated health: Odds ratios Log scale Reference: Occasional Drinker Unadjusted odd ratios 10 1 0.1 Low risk: weekly Low risk: daily Focal: Hazardous Focal: High Risk Heavy: Hazardous Heavy: High Risk Heavy: Hazardous Heavy: High Risk Odds ratios: Log scale Reference: Occasional Drinker Adjusted odds ratios 10 1 0.1 Low risk: weekly Low risk: daily Focal: Hazardous Focal: High Risk Adjusted for: Age, gender, wealth, social class, education, household size, smoking, BMI Longitudinal Analysis • Multilevel level longitudinal analysis using alcohol variables in waves 0, 4 and 5 • Quantity: – Growth curve model of log of weekly units of alcohol consumed – Restricted to drinkers at all 3 time points (3610 valid cases) • Frequency – Ordered logistic regression using frequency of drinking in last 12 months – Restricted to respondents at all 3 time points (4740 valid cases) 123456789 1011121314151617181920 Figure 4: Average weekly units over time by gender 0 4 wave sex=male sex=female 5 Table 2: Average weekly units consumed for synthetic profiles of older people Pauline: Pearl: Doreen: Dorothy: In partnership, Retired, Good health, Some qualifications, Non-smoker, Average Wealth Not in partnership, Retired, Not in good health, No qualifications, Non-smoker, Lowest wealth group In partnership, Working, Good health, University degree , Former smoker, Highest wealth group During 10 year period: • Loses partner, retires & health deteriorates A level qualifications Non-smoker, Above average wealth Age 60 Age 70 Age 80 Age 90 Age 50 Age 60 Age 60 Age 70 3.95 3.50 (11%) 3.43 2.92 (15%) 11.92 10.18 (15%) 5.84 4.54(22%) Paul: Peter: Duncan: Derek: In partnership, Retired, Good health, Some qualifications, Nonsmoker, Average Wealth Not in partnership, Retired Not in good health No qualifications Non-smoker Lowest wealth group During 10 year period: • Gets married Working, Good health, University degree, Former smoker, Highest wealth group During 10 year period: • Loses partner, retires & health deteriorates A level qualifications Non-smoker Above average wealth Age 65 Age 75 Age 80 Age 90 Age 50 Age 60 Age 60 Age 70 6.75 5.76 (15%) 7.47 6.04 (19%) 33.80 28.0 (17%) 7.76 6.81 (12%) Figure 5: Percentage distribution of drinking frequency waves 0 and 5 Wave 0 30 25 20 15 10 5 0 Wave 5 Did not Drinks Drinks drink in Once or once last year twice a every year couple of months Number of cases = 4780 Drinks Drinks once or one to twice a two days month a week Drinks Drinks Drinks three to five to six almost four days days a every day a week week Table 3: Summary of results of longitudinal model of frequency of drinking - 1 Variable Time (continuous variable) Partnership status Reference: Always in partnership • Always out of partnership • Enters into partnership between waves • Partnerships ends between waves Employment status Reference: Always in work • Always retired • Transition to retirement between waves Health: Reference always in good health • Always in poor health • Health worsens between waves • Health improves between waves Men -0.11 Women -0.16 0.28 0.56 0.03 -0.07 0.47 -0.08 0.28 -0.08 0.55 0.13 -0.61 -0.25 -0.77 -1.21 -0.12 -0.76 Table 3: Summary of results of longitudinal model of frequency of drinking - 2 Men Wealth Quintile Reference category: Bottom Quintile • 2nd Quintile • 3rd Quintile • 4th Quintile • 5th Quintile Education: Reference: No qualifications • Some qualifications • A-level or equivalent • Degree Women 0.48 0.63 0.75 1.41 0.52 0.80 1.42 1.97 0.28 0.39 1.41 0.59 0.80 1.16 Table 3: Summary of results of longitudinal model of frequency of drinking - 3 Variable Partnership status * Time Reference: Always in partnership • Always out of partnership • Enters into partnership between waves • Partnerships ends between waves Health: * Time Reference always in good health • Always in poor health • Health worsens between waves • Health improves between waves Men Women -0.10 -0.01 -0.02 -0.09 -0.07 -0.07 -0.14 -0.09 -0.06 -0.12 -0.13 -0.02 Main Findings: Drinking, socio-economic status and partnership • Older men tend to drink more and to drink more often than women. • Men and women in higher income groups and with higher levels of education drink more and drink more frequently. • Both the amount that older people drink and how often they drink declines over time. • Men who are not in a partnership drink more compared to men with a partner, though there is no difference in the frequency of men’s drinking by partnership status. • For women loss of a partner is associated with a faster decline in weekly alcohol consumption and with drinking less often. Main Findings: Drinking in later life and health • Poorer self-rated health is associated with not drinking. • Among drinkers, there is no evidence that a moderate amount of alcohol consumption improves health in later life compared to heavy drinking. • Over time older people with poor self-rated health and deteriorating health report a steeper decline in the quantity and frequency of alcohol consumed (similar finding for depression). • Those who stopped drinking at the start of the period of observation and remained in the study were more likely to experience an improvement in health compared to drinkers. Policy Implications • • • • • Rethink causality between health and drinking in later life? Older people moderate their drinking if their health declines. But the message that moderate drinking is good for you is not supported by this analysis. Furthermore for this sample we did not find that excessive drinking causes a deterioration of health in later life. Those who stopped drinking were more likely to experience an improvement in health compared to drinkers so cessation may be recommended for older people in poor health. Those at most risk of drinking in excess and drinking most frequently are well educated and have high wealth. This is a concern particularly as the prosperity of older people improves then this may lead to more people drinking excessively in later life. This group of successful older people could be resistant to public health messages. •“The Partnership makes a difference much people drinkin though differs public health message shouldto behow make sureolder you’ve got things place,this go and forfriends, men and women. The you social of drinking is important andit advice about make you know, get lifecontext organised so that you’re enjoying because I drinking needs to be asensitive to partnership status. think again anecdotally lot of men don’t maintain contact with people”